Could Uterine Adhesions Be the Cause of My Irregular Periods?

Is it uterine adhesions?

Hello, doctor.
Since May, my menstrual cycle has been irregular.
Could this be related to taking the emergency contraceptive pill in April? In mid-May, I had some spotting, which I thought was my period, but it stopped the next day.
I went to see a gynecologist, and the doctor said that it didn't count as a period.
During the pelvic exam, it was found that menstrual blood was not flowing out, and I was advised to take medication to induce menstruation.
After taking it, I had a normal period for a day and a half, but then it stopped again.
The doctor prescribed medication to regulate my cycle, but as of now, my period still hasn't come.
For the past few days, I've been feeling a dull pain in my lower abdomen, similar to menstrual cramps, but my period hasn't arrived.
I'm wondering if there could be adhesions in my uterus.
I had a surgical abortion a year and a half ago, and my periods were normal afterward.
Is it possible for adhesion issues to arise a year and a half later? Thank you.

Xiao Yu, 20~29 year old female. Ask Date: 2018/06/24

Dr. Huang Jianzhong reply Obstetrics and Gynecology

1.
Since May, my menstrual cycle has been irregular.
Could it be related to taking emergency contraceptive pills in April? Answer: It is possible.
In mid-May, I experienced some spotting, which I thought was my period, but it stopped the next day.
I went to see a gynecologist, who said that it did not count as a menstrual period.
During the examination, it was found that menstrual blood was not flowing out, and I was advised to take medication to induce menstruation.
After taking it, I had a normal period for a day and a half, but then it stopped again.
The doctor prescribed medication to regulate my cycle, but so far, my period has not returned.
For the past few days, I have been feeling a dull pain in my lower abdomen, similar to menstrual cramps, but my period has not come.
I am wondering if it could be due to uterine adhesions, as I had a surgical abortion a year and a half ago, and my menstrual cycle had been normal since then.
2.
Is it possible to have adhesion issues a year and a half later? Answer: It is not likely to develop adhesion issues a year and a half later.

Reply Date: 2018/06/24

More Info

Uterine adhesions, also known as Asherman's syndrome, can indeed be a potential cause of irregular periods. These adhesions occur when scar tissue forms inside the uterus, often as a result of surgical procedures such as dilation and curettage (D&C), which is commonly performed after miscarriages or abortions. The scar tissue can interfere with the normal shedding of the uterine lining during menstruation, leading to irregularities in your menstrual cycle.

In your case, it is possible that the irregularities you are experiencing since May could be related to the uterine adhesions resulting from your previous abortion. While it is not common for adhesions to develop long after the procedure, it is not impossible. The formation of adhesions can sometimes take time, and symptoms may not manifest until later.
The symptoms you describe, such as the absence of a regular menstrual flow, abdominal discomfort resembling menstrual cramps, and the unusual bleeding you experienced in May, could all be indicative of a problem with the uterine lining. When the lining does not shed properly due to adhesions, it can lead to a variety of menstrual irregularities, including light bleeding, missed periods, or even prolonged bleeding.

It is also worth noting that hormonal fluctuations, particularly after taking emergency contraception, can lead to temporary changes in your menstrual cycle. Emergency contraceptives can cause your next period to be earlier, later, lighter, or heavier than usual. However, since you have been experiencing ongoing issues with your cycle, it is crucial to investigate further.

Given your history of a surgical procedure and the current symptoms, it is advisable to follow up with your healthcare provider. They may recommend imaging studies, such as a hysterosalpingogram (HSG) or a sonohysterogram, to assess the condition of your uterus and check for any adhesions or abnormalities. If adhesions are confirmed, treatment options may include hysteroscopic surgery to remove the scar tissue and restore normal menstrual function.

In conclusion, while hormonal changes from emergency contraception could contribute to your irregular periods, the possibility of uterine adhesions should not be overlooked, especially considering your surgical history. It is essential to work closely with your healthcare provider to determine the underlying cause of your symptoms and to develop an appropriate treatment plan. Regular monitoring and open communication about your symptoms will be key in managing your menstrual health effectively.

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